The role of agonist and antagonist muscles in explaining isometric knee extension torque variation with hip joint angle

Effect of muscle length on maximum evoked torque, discomfort, contraction fatigue, and strength adaptations during electrical stimulation in adult populations: A systematic review

Neuromuscular electrical stimulation (NMES) can improve physical function in different populations. NMES-related outcomes may be influenced by muscle length (i.e., joint angle), a modulator of the force generation capacity of muscle fibers. Nevertheless, to date, there is no comprehensive synthesis of the available scientific evidence regarding the optimal joint angle for maximizing the effectiveness of NMES. We performed a systematic review to investigate the effect of muscle length on NMES-induced torque, discomfort, contraction fatigue, and strength training adaptations in healthy and clinical adult populations (PROSPERO: CRD42022332965). We conducted searches across seven electronic databases: PUBMED, Web of Science, EMBASE, PEDro, BIREME, SCIELO, and Cochrane, over the period from June 2022 to October 2023, without restricting the publication year. We included cross-sectional and longitudinal studies that used NMES as an intervention or assessment tool for comparing muscle lengths in adult populations. We excluded studies on vocalization, respiratory, or pelvic floor muscles. Data extraction was performed via a standardized form to gather information on participants, interventions, and outcomes. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for cross-over trials and the Physiotherapy Evidence Database scale. Out of the 1185 articles retrieved through our search strategy, we included 36 studies in our analysis, that included 448 healthy young participants (age: 19-40 years) in order to investigate maximum evoked torque (n = 268), contraction fatigability (n = 87), discomfort (n = 82), and muscle strengthening (n = 22), as well as six participants with spinal cord injuries, and 15 healthy older participants. Meta-analyses were possible for comparing maximal evoked torque according to quadriceps muscle length through knee joint angle. At optimal muscle length 50° - 70° of knee flexion, where 0° is full extension), there was greater evoked torque during nerve stimulation compared to very short (0 - 30°) (p<0.001, CI 95%: -2.03, -1.15 for muscle belly stimulation, and -3.54, -1.16 for femoral nerve stimulation), short (31° - 49°) (p = 0.007, CI 95%: -1.58, -0.25), and long (71° - 90°) (p<0.001, CI 95%: 0.29, 1.02) muscle lengths. At long muscle lengths, NMES evoked greater torque than very short (p<0.001, CI 95%: -2.50, -0.67) and short (p = 0.04, CI 95%: -2.22, -0.06) lengths. The shortest quadriceps length generated the highest perceived discomfort for a given current amplitude. The amount of contraction fatigability was greater when muscle length allowed greater torque generation in the pre-fatigue condition. Strength gains were greater for a protocol at the optimal muscle length than for short muscle length. The quality of evidence was very high for most comparisons for evoked torque. However, further studies are necessary to achieve certainty for the other outcomes. Optimal muscle length should be considered the primary choice during NMES interventions, as it promotes higher levels of force production and may facilitate the preservation/gain in muscle force and mass, with reduced discomfort. However, a longer than optimal muscle length may also be used, due to possible muscle lengthening at high evoked tension. Thorough understanding of these physiological principles is imperative for the appropriate prescription of NMES for healthy and clinical populations.

The Influence of Hip and Knee Joint Angles on Quadriceps Muscle-Tendon Unit Properties during Maximal Voluntary Isometric Contraction

Determining how the quadriceps femoris musculotendinous unit functions, according to hip and knee joint angles, may help with clinical decisions when prescribing knee extension exercises. We aimed to determine the effect of hip and knee joint angles on structure and neuromuscular functioning of all constituents of the quadriceps femoris and patellar tendon properties. Twenty young males were evaluated in four positions: seated and supine in both 20° and 60° of knee flexion (SIT20, SIT60, SUP20, and SUP60). Peak knee extension torque was determined during maximal voluntary isometric contraction (MVIC). Ultrasound imaging was used at rest and during MVIC to characterize quadriceps femoris muscle and tendon aponeurosis complex stiffness. We found that peak torque and neuromuscular efficiency were higher for SUP60 and SIT60 compared to SUP20 and SIT20 position. We found higher fascicle length and lower pennation angle in positions with the knee flexed at 60°. The tendon aponeurosis complex stiffness, tendon force, stiffness, stress, and Young's modulus seemed greater in more elongated positions (60°) than in shortened positions (20°). In conclusion, clinicians should consider positioning at 60° of knee flexion rather than 20°, regardless if seated or supine, during rehabilitation to load the musculotendinous unit enough to stimulate a cellular response.

Hip and Knee Joint Angles Determine Fatigue Onset during Quadriceps Neuromuscular Electrical Stimulation

Neuromuscular electrical stimulation (NMES) has been used to increase muscle strength and physical function. However, NMES induces rapid fatigue, limiting its application. To date, the effect of quadriceps femoris (QF) muscle length by knee and hip joint manipulation on NMES-induced contraction fatigability is not clear. We aimed to quantify the effects of different muscle lengths on NMES-induced contraction fatigability, fatigue index, and electromyographic (EMG) activity for QF muscle. QF maximum evoked contraction (QMEC) was applied in a 26 min protocol (10 s on; 120 s off; 12 contractions) in 20 healthy participants (24.0 ± 4.6 years old), over 4 sessions on different days to test different conditions. The tested conditions were as follows: supine with knee flexion of 60° (SUP60), seated with knee flexion of 60° (SIT60), supine with knee flexion of 20° (SUP20), and seated with knee flexion of 20° (SIT20). Contraction fatigability (torque decline assessed by maximal voluntary contraction [MVC] and during NMES), fatigue index (percentage reduction in MVC), and EMG activity (root mean square [RMS] and median frequency) of the superficial QF' constituents were assessed. After NMES, all positions except SUP20 had an absolute reduction in MVC (p < .001). Fatigue index was greater in SIT20 than in SIT60 (p < .001) and SUP20 (p = .01). There was significant torque reduction across the 12 QMEC in SUP60 and SIT60, up to 10.5% (p < .001–.005) and 9.49% (p < .001–.033), respectively. There was no torque reduction during NMES in SUP20 and SIT20. Fatigue was accompanied by an increase in RMS (p = .032) and a decrease in median frequency for SUP60 (p < .001). Median frequency increased only in the SUP20 condition (p = .021). We concluded that QF NMES-induced contraction fatigability is greater when the knee is flexed at 60° compared to 20°. In addition, a supine position promotes earlier fatigue for a 60° knee flexion, but it delays fatigue onset for a 20° knee flexion compared to the seated position. These results provide a rationale for lower limb positioning during NMES, which depends on training objectives, e.g., strengthening or task-specific functionality training.

Effect of the Knee and Hip Angles on Knee Extensor Torque: Neural, Architectural, and Mechanical Considerations

This study examined the influence of knee extensors' hip and knee angle on force production capacity and their neuromuscular and architectural consequences. Sixteen healthy men performed sub-maximal and maximal voluntary isometric contractions (MVIC) of knee extensors with four different combinations of the knee and hip angles. Muscle architecture, excitation-contraction coupling process, muscular activity, and corticospinal excitability were evaluated on the vastus lateralis (VL) and rectus femoris (RF) muscles. MVIC and evoked peak twitch (Pt) torques of knee extensors increased significantly (p < 0.05) by 42 ± 12% and 47 ± 16% on average, respectively, under knee flexed positions (110° flexion, 0° = full extension) compared to knee extended positions (20° flexion) but were not different between hip positions (i.e., 0° or 60° flexion). Knee flexion also affected VL and RF muscle and fascicle lengths toward greater length than under knee extended position, while pennation angle decreased for both muscles with knee flexion. Pennation angles of the VL muscle were also lower under extended hip positions. Alternatively, no change in maximal muscle activation or corticospinal activity occurred for the VL and RF muscles across the different positions. Altogether these findings evidenced that MVIC torque of knee extensors depended particularly upon peripheral contractile elements, such as VL and RF muscle and fascicle lengths, but was unaffected by central factors (i.e., muscle activation). Furthermore, the hip position can affect the pennation angle of the VL, while VL muscle length can affect the pennation angle of the RF muscle. These elements suggest that the VL and RF muscles exert a mutual influence on their architecture, probably related to the rectus-vastus aponeurosis.

Effects of resistance training at different intensities of load on cross-education of muscle strength

The objectives of this study were 1) to compare the extent of cross-transfer of high- versus low-load unilateral resistance training performed with external pacing of the movement (URTEP) and 2) to compare the time course of the two approaches. Fifty subjects were randomized to one of the following three groups: G80 [two sets at 80% and two sets at 40% of one maximum repetition (1RM), 1 concentric second and 3 eccentric seconds controlled by a metronome]; G40 (four sets at 40% of 1 RM, 1s and 3s controlled by a metronome); or CG (control group). At week 1, the G80 increased the elbow flexion 1RM (P<0.05) in contralateral arm. At week 4, both G80 and G40 increased the elbow flexion 1RM (P<0.05) in contralateral arm. However, a greater 1RM gain was observed in the G80 than in the G40 (P< .05). Thus, although higher-load URTEP seems to enhance the cross-education effect when compared to lower-load URTEP, the cross-education of dynamic strength can be achieved in the two approaches after four weeks. Many patients would benefit from cross-education of muscle strength through URPEP, even who are unable to exercise with high loads and in short periods of immobilization. Novelty bullets: (1) Unilateral resistance training promotes cross-education of dynamic muscle strength. (2) However, higher-load resistance training enhances the effects of cross-education of muscle strength.

The Effect of Quadriceps Muscle Length on Maximum Neuromuscular Electrical Stimulation Evoked Contraction, Muscle Architecture, and Tendon-Aponeurosis Stiffness

Muscle-tendon unit length plays a crucial role in quadriceps femoris muscle (QF) physiological adaptation, but the influence of hip and knee angles during QF neuromuscular electrical stimulation (NMES) is poorly investigated. We investigated the effect of muscle length on maximum electrically induced contraction (MEIC) and current efficiency. We secondarily assessed the architecture of all QF constituents and their tendon-aponeurosis complex (TAC) displacement to calculate a stiffness index. This study was a randomized, repeated measure, blinded design with a sample of twenty healthy men aged 24.0 ± 4.6. The MEIC was assessed in four different positions: supine with knee flexion of 60° (SUP60); seated with knee flexion of 60° (SIT60); supine with knee flexion of 20° (SUP20), and seated with knee flexion of 20° (SIT20). The current efficiency (MEIC/maximum tolerated current amplitude) was calculated. Ultrasonography of the QF was performed at rest and during NMES to measure pennation angle (θ p ) and fascicle length (L f ), and the TAC stiffness index. MEIC and current efficiency were greater for SUP60 and SIT60 compared to SUP20 and SIT20. The vastus lateralis and medialis showed lower θ p and higher L f at SUP60 and SIT60, while for the rectus femoris, in SUP60 there were lower θ p and higher L f than in all positions. The vastus intermedius had a similar pattern to the other vastii, except for lack of difference in θ p between SIT60 compared to SUP20 and SIT20. The TAC stiffness index was greater for SUP60. We concluded that NMES generate greater torque and current efficiency at 60° of knee flexion, compared to 20°. For these knee angles, lengthening the QF at the hip did not promote significant change. Each QF constituent demonstrated muscle physiology patterns according to hip and/or knee angles, even though a greater L f and lower θ p were predominant in SUP60 and SIT60. QF TAC index stiffened in more elongated positions, which probably contributed to enhanced force transmission and slightly higher torque in SUP60. Our findings may help exercise physiologist better understand the impact of hip and knee angles on designing more rational NMES stimulation strategies.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier NCT03822221.

Local fat content and muscle quality measured by a new electrical impedance myography device: correlations with ultrasound variables

AbstractThe present study investigated the relationship between local fat percentage (SK_fat) and muscle quality (MQ) estimated by a new hand-held electrical impedance myography (hEIM) device or derived from ultrasound and strength assessments. The right anterior thigh of 90 healthy participants (mean ± SD; age=22.9 ± 2.9 years; 45 men: BMI = 23.9 ± 2.4 kgm^-2; 45 women: BMI = 21.1 ± 1.9 kgm^-2) was scanned by hEIM and ultrasound. Correlations between SK_fat, local subcutaneous fat (SUB_fat), and echo intensity (EI_us) were explored. Correlations between MQ, EI_us, quadriceps femoris anatomical cross-sectional area (ACSA_QF), knee extensors maximum voluntary isometric torque (T), T/ACSA_QF, EI_us/SUB_fat, and ACSA_QF/SUB_fat were also assessed. SK_fat correlated with SUB_fat (r = 0.88; p < 0.001) and EI_us (r = 0.64; p < 0.001). MQ correlated with EI_us (r = -0.66; p < 0.001), ACSA_QF (r = 0.37; p < 0.001), EI_us/SUB_fat (r = 0.37; p < 0.001), and ACSA_QF/SUB_fat (r = 0.81; p < 0.001). Multiple regression analysis showed that SUB_fat, EI_us, and sex explained 86% of SK_fat variance, whereas ACSA_QF/SUB_fat, sex and EI_us explained 75% of MQ variance. In conclusion, high hEIM local fat percentage relates to greater subcutaneous fat and intramuscular non-contractile tissue content. High hEIM muscle quality relates to greater muscle-size:subcutaneous-fat ratio and contractile tissue content. Sex influences the prediction of both parameters. This hEIM device seems to be useful to estimate local thigh composition.

Do Surface Slope and Posture Influence Lower Extremity Joint Kinetics during Cycling?

The purpose of this study was to investigate the effects of surface slope and body posture (i.e., seated and standing) on lower extremity joint kinetics during cycling. Fourteen participants cycled at 250 watts power in three cycling conditions: level seated, uphill seated and uphill standing at a 14% slope. A motion analysis system and custom instrumented pedal were used to collect the data of fifteen consecutive cycles of kinematics and pedal reaction force. One crank cycle was equally divided into four phases (90° for each phase). A two-factor repeated measures MANOVA was used to examine the effects of the slope and posture on the selected variables. Results showed that both slope and posture influenced joint moments and mechanical work in the hip, knee and ankle joints (p < 0.05). Specifically, the relative contribution of the knee joint to the total mechanical work increased when the body posture changed from a seated position to a standing position. In conclusion, both surface slope and body posture significantly influenced the lower extremity joint kinetics during cycling. Besides the hip joint, the knee joint also played the role as the power source during uphill standing cycling in the early downstroke phase. Therefore, adopting a standing posture for more power output during uphill cycling is recommended, but not for long periods, in view of the risk of knee injury.

Maximal contraction methods influence the magnitude and reliability of global electromyographic signal characteristics

OBJECTIVE

The purpose was two-fold: (1) to examine differences in maximal voluntary isometric torque (MVIT) production, and electromyographic signal amplitude (EMG_AMP) and mean power frequency (EMG_MPF) values obtained during traditional (MVIC_TRAD), rapid (MVIC_RAPID), and ramp (MVIC_RAMP) maximal voluntary isometric contractions, and (2) to determine if there were differences in the reliability of MVIT, EMG_AMP and EMG_MPF among the three MVIC types.

APPROACH

Twenty-two young males and females completed MVIC_TRAD, MVIC_RAPID, and MVIC_RAMP muscle actions on two separate visits separated by 48 h. During all MVICs, MVIT and EMG_AMP and EMG_MPF of the vastus lateralis (VL) and rectus femoris (RF) were quantified.

MAIN RESULTS

MVIT was greater during MVIC_TRAD and MVIC_RAPID than during MVIT_RAMP (both p < 0.001). VL and RF EMG_AMP were greater during MVIC_RAMP than during MVIC_RAPID (p = 0.02 and 0.004). For EMG_MPF, there were no significant differences among MVIC types. Although all MVIC types generally resulted in reliable measurements of MVIT and EMG_AMP, reliability was stronger for EMG_MPF quantified during the MVIC_RAMP.

SIGNIFICANCE

Investigators may choose MVIC type based on preference or equipment availability. However, investigators should note that MVIC_RAMP contractions will likely yield the greatest EMG_AMP values and more reliable measurements of VL and RF EMG_MPF.

Fatigue and recovery measured with dynamic properties versus isometric force: effects of exercise intensity

Although fatigue can be defined as an exercise-related decrease in maximal power or isometric force, most studies have assessed only isometric force. The main purpose of this experiment was to compare dynamic measures of fatigue [maximal torque (T _max), maximal velocity (V _max) and maximal power (P _max)] with measures associated with maximal isometric force [isometric maximal voluntary contraction (IMVC) and maximal rate of force development (MRFD)] 10 s after different fatiguing exercises and during the recovery period (1-8 min after). Ten young men completed six experimental sessions (3 fatiguing exercises×2 types of fatigue measurements). The fatiguing exercises were: 30 s all-out intensity (AI), 10 min at severe intensity (SI) and 90 min at moderate intensity (MI). Relative P _max decreased more than IMVC after AI exercise (P=0.005) while the opposite was found after SI (P=0.005) and MI tasks (P<0.001). There was no difference between the decrease in IMVC and T _max after the AI exercise, but IMVC decreased more than T _max immediately following and during the recovery from the SI (P=0.042) and MI exercises (P<0.001). Depression of MRFD was greater than V _max after all fatiguing exercises and during recovery (all P<0.05). Despite the general definition of fatigue, isometric assessment of fatigue is not interchangeable with dynamic assessment following dynamic exercises with large muscle mass of different intensities, i.e. the results from isometric function cannot be used to estimate dynamic function and vice versa. This implies different physiological mechanisms for the various measures of fatigue.

CORP: Measurement of upper and lower limb muscle strength and voluntary activation

Muscle strength, the maximal force-generating capacity of a muscle or group of muscles, is regularly assessed in physiological experiments and clinical trials. An understanding of the expected variation in strength and the factors that contribute to this variation is important when designing experiments, describing methodologies, interpreting results, and attempting to replicate methods of others and reproduce their findings. In this review (Cores of Reproducibility in Physiology), we report on the intra- and inter-rater reliability of tests of upper and lower limb muscle strength and voluntary activation in humans. Isometric, isokinetic, and isoinertial strength exhibit good intra-rater reliability in most samples (correlation coefficients ≥0.90). However, some tests of isoinertial strength exhibit systematic bias that is not resolved by familiarization. With the exception of grip strength, few attempts have been made to examine inter-rater reliability of tests of muscle strength. The acute factors most likely to affect muscle strength and serve as a source of its variation from trial-to-trial or day-to-day include attentional focus, breathing technique, remote muscle contractions, rest periods, temperature (core, muscle), time of day, visual feedback, body and limb posture, body stabilization, acute caffeine consumption, dehydration, pain, fatigue from preceding exercise, and static stretching >60 s. Voluntary activation, the nervous system’s ability to drive a muscle to create its maximal force, exhibits good intra-rater reliability when examined with twitch interpolation (correlation coefficients >0.80). However, inter-rater reliability has not been formally examined. The methodological factors most likely to influence voluntary activation are myograph compliance and sensitivity; stimulation location, intensity, and inadvertent stimulation of antagonists; joint angle (muscle length); and the resting twitch.